1 Dec 10
Case Study: Torsade de Pointes in the End-of-Life Setting
- Tue, 11/30/10 - 4:56pm
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In this brief case study, the authors report on torsade de pointes brought on by methadone treatment.
Case Description
A 46-year-old female with end-stage colorectal cancer presents to the Emergency Room (ER) with near syncope. She was brought to the ER by her husband, where she was found to be in ventricular tachycardia (VT). She was immediately treated with cardioversion, magnesium 2 grams intravenous (IV), followed by administration of an amiodarone bolus of 300 mg IV. She was subsequently admitted to the hospital where she had four more episodes of sustained VT which was torsade de pointes. She was given another amiodarone bolus and defibrillated four times. Resting electrocardiogram (EKG) showed significant QTc prolongation. The patient states that she has been getting treated for chronic pain (secondary to end-stage cancer) with the following medications: methadone, oxycontin, and a “pain pump.”
Atrial Fibrillation Ablation: Go Big or Go Home!
- Tue, 11/30/10 - 5:10pm
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The prevalence of atrial fibrillation (AF) and the achievable benefits offered by evolving ablation protocols are undeniable. As such, we can expect to see the volume of AF ablation cases continue to remain steady for years to come — potentially indefinitely. The demand for AF ablation and the gratitude received from cured patients make this a very attractive service to offer. However, the EP community may benefit from shifting the bulk of AF ablations to facilities and physicians dedicated to performing a high volume of atrial fibrillation ablations (AF Magnet centers).
AHA 2010: Meeting Highlights
- Tue, 11/30/10 - 5:25pm
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The American Heart Association Scientific Sessions took place November 13-17, 2010 in Chicago. Enclosed below is a compilation of clinical news highlights from the meeting.
AHA: Prescription omega-3 No Better Than Placebo in Treating AF
Prescription omega-3 fatty acids didn’t prevent the recurrence of the most common type of erratic beats in the heart’s upper chambers, according to late-breaking clinical trial research presented at the American Heart Association’s Scientific Sessions 2010.
Efficacy and Safety of Prescription Omega-3 Acid Ethyl Esters (P-OM3) for the Prevention of Recurrent Symptomatic Atrial Fibrillation is a prospective, randomized, double-blind trial of 663 patients (average age 61, 56 percent male) enrolled at 96 sites.
In the study, researchers compared the use of the fish-oil-derived product (4grams/day) and a placebo in patients with paroxysmal atrial fibrillation (AF).
Letter to the Editor
- Tue, 11/30/10 - 6:10pm
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- 808 reads
Dear Dr. Knight,
As an academic-trained EP practicing at a small, community hospital, I saw the title of your column [“Saturday Morning at a Small Community Hospital”, EP Lab Digest 2010;10:4.] and started reading with an expectation of the typical conclusion recommending referral of EP patients to quaternary care centers.
The Emerging Indications for Epicardial Access During Catheter Ablation
- Tue, 11/30/10 - 6:54pm
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- 4741 reads
Endocardial catheter-based ablation has revolutionized the field of cardiac electrophysiology to a therapeutic subspecialty. Over the last decade, it has become apparent an epicardial approach is needed to successfully ablate certain arrhythmias. Additionally, the use of epicardial access has been used to make endocardial ablation safer by adding techniques to protect nearby vital structures. The objective of this article is to review the procedure of percutaneous epicardial puncture and the indications for epicardial ablation for ventricular tachycardia, atrial fibrillation, and supraventricular tachycardia.
Percutaneous Epicardial Puncture
Unusual Causes of Sudden Cardiac Death
- Tue, 11/30/10 - 1:26pm
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Sudden cardiac death (SCD) is defined as unexpected natural death from a cardiac cause heralded by abrupt loss of consciousness within a short time period, generally less than 1 hour from the onset of symptoms.1 Pre-existing heart disease may or may not have been known to be present, but the time and mode of death are unexpected. Current estimates place the incidence of sudden cardiac death (SCD) between 180,000 to 400,000 per year.2–4 Ischemic cardiomyopathy, nonischemic cardiomyopathy, and primary electrical disorders are well-recognized causes of SCD.2,5
Shifting Trends: Why Cardiologists Nationwide are Seeking Employment
- Tue, 11/30/10 - 2:16pm
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- 4911 reads
Healthcare today is challenging for both hospitals and physicians. Together, they are committed to providing quality care, but are faced with having to provide best-practice care to increasing numbers of patients, but with fewer resources, a shrinking pool of specialists, and declining reimbursements.
The uncertainty of healthcare reform, declining reimbursement, and an eroding practice income has cardiology groups seeking ways to stay financially whole. For instance, non-invasive testing procedures (nuclear stress tests, EKGs, etc.) are not as financially lucrative as they once were due to a continued ratcheting down of professional fees coupled with changes to the Sustainable Growth Rate formula. Further, these specialists are concerned about additional CMS projected reimbursement cuts scheduled for 2011.
In Defense of Legitimate Relationships Between Physicians and Industry
- Tue, 11/30/10 - 2:51pm
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- 2237 reads
Dear Readers,
There has been a great deal of negative attention lately to relationships between physicians and industry. A front-page story in the Chicago Tribune newspaper in October was devoted to a list of all physicians in the Chicago area who received over $100,000 in compensation from the pharmaceutical industry in the past year.1 It does seem that something is awry when an individual practicing physician earns $250,000 from a drug company, but the reactions by the media, legislators, and some professional medical associations (PMAs) have demonized all relationships between physicians and industry.
East Carolina Heart Institute at Pitt County Memorial Hospital
- Tue, 11/30/10 - 3:10pm
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- 4205 reads
What is the size of your EP lab facility and number of staff members?
Our EP lab consists of 1 bi-plane Philips lab and 2 single-plane Philips labs, a Tilt room, and the pacemaker clinic. We also share a Philips bi-plane cath lab when a fourth lab is needed; this lab is equipped to perform cath or EP procedures. We have six electrophysiologists who are a mix of private and academic physicians. One of our six EP physicians is a pediatric electrophysiologist. We employ 7 RNs (8 including a manager), 10.5 CVTs, and a technical assistant.
What is the mix of credentials at your lab?
All nurses are RNs. All CVTs are RTs, except one who is a respiratory therapist, who is cross-trained to function as an RT. Our technical assistant has a certification as a nurse aide II (care partner).
When was the EP lab started at your institution?
ICD Implantation in Evolution
- Tue, 11/30/10 - 3:30pm
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- 3527 reads
New trends in ICD implantation offer additional options as well as potential challenges for ICD implanters. In this article, the author discusses the benefits of these new technologies, including improved patient outcomes and the potential for simpler and safer procedures.
